Sunday, February 17, 2008

Abolish this centrally regulated health system

There are two amusing—well, amusing for a chronicler of state folly and who is, additionally, a mere onlooker—stories concerning the NHS that I feel beholden to flag up.

The first comes courtesy of the Britmeds, and discusses the lack of doctors.
I wrote before about the bizarre state that we find ourselves in regarding staffing. Despite the ridiculous shambles of MMC 2007 that left the majority of junior doctors in specialist training either displaced or unemployed, we now find ourselves in a position where there aren’t enough doctors in the hospital to staff a rota.

The situation has now been picked up by Channel 4 and The Telegraph (the BBC, as always remain silent).

Junior doctor jobs are vacant, and trusts up and down the land are having to scrabble around to find emergency locum appointments at the cost of thousands of pounds per week.

The situation is getting worse and worse on almost by the week. Doctors are completing their training and are taking up consultant jobs, taking a break or going to work elsewhere and, because or MMC, NewTown NHS trust is not able to replace them until August.

This means more positions are being left vacant, more pressure is put on the remaining doctors to do the work and the NewTown NHS Trust is having to fork out more and more money to pay for locums to cover the shifts.

To put into perspective how bad things have become, in February 2007 (pre-MMC) there were 12 junior doctors (SHOs) on the anaesthetics rota at NewTown Hospital, today, there are five. Five doctors are doing the work of twelve.

One wonders when people are going to get the message that top-down management of a system as large as the NHS simply doesn't fucking work. We have endless stories about doctors leaving the profession, or emigrating to find jobs, and yet hospitals up and down the country are crying out for... well... any doctors. This is utter insanity.

As is, of course, the fact that patients are being kept in ambulances for hours so that A&E departments can meet their targets.
I know this will come as a terrible shock to regular readers, but the Guardian has 'discovered' that A&E departments up and down the country are keeping sick patients in ambulances for hours to meet their '4 hour targets'.

Who would have guessed it?

Well, I suppose if the Mainstream Media (MSM) had actually bothered to read the medical blogs A YEAR AGO, they might realise that this is NOT NEWS.

Still, better late than never.


This is doubly troubling, of course, because not only are patients not being seen in (what the government deems to be) a reasonable time, but those ambulances are not available to answer other 999 calls.

Ladies and gentlemen; I give you... the NHS. A big hand for the NHS, ladies and gentlemen, the Wonder of the World.

Fucking hellski.


Anonymous said...

The NHS was never necessary. It was a communist construct at the time, although they positioned it as "caring". Health care has always been available to everyone in Britain.

Before the NHS, most working people were able to afford small health policies. This was before the immense advancement we have seen in treatment and medical technology - so insurance covered tonselectomies, appendectomies and various other commonplace ailments - and births, of course - none of which were expensive to treat.

Trades unions also covered their members with medical insurance. For people without a membership in a trades union and without a job, employers would sometimes pick up the tab. For those with no resources at all, the churches helped, as did many charities set up for the purpose.

There was absolutely no reason to introduce the NHS. And then they dubbed it "the envy of the world". The "stupidity of the world" might have been more apt.

Now, as with all socialist/communist programmes, it is way out of control.

Take an axe and kill it. Or throw it into competition for funds by giving the punters a choice of where their NI contribution should be directed. My guess: within five years, the NHS would be out of business because it would not be able to compete with private care.

There should be four or five health care companies - or 20 or 100 - whatever the market demands - and every one of them should be listed as being qualified to receive NI payments when nominated.

I see the NHS as a ravening beast. Over a million employees! That figure makes my stomach lurch.

Guarantee: if there were real competition for NI deductions, we would not see hospital deaths due to filthy wards. We also would not see the disgraceful mixed wards. We would see the private sector employing matrons with real authority.

Anonymous said...

Ah the four hour A&E target: a case study in how the world does and doesn't work.

How would you feel if you waited four hours for a traffic light to change: would people be honking? Its a long time! The performance of A&E is symptom of how well the rest of the hospital performs. No beds available for admissions because the process of discharge is effn useless. Nothing wrong with a four hour target. If anything its too weak!

But look what happens. Some Hospitals get into shape and lo and behold everything works better - result for patients. Other just cheat, move the patient from A&E to an "observation ward" and the same useless system avoids changing but the hospital claims it has met the target less than four hours to admission or discharge.

Now the politicians start to crucify any hospital management that doesn't meet the four hour target - and turns a blind eye to whether its met by cheating or by reform, because ministers want to claim things have improved EVEN IF THEY HAVEN'T.

The real world is notoriously difficult to change. Much easier to write a press release claiming it has changed.

In A&E some of the most sick patients in hospital are faced by the most inexperienced junior doctors in training. Its the public who don't understand. They hope A&E will save their lives. Little do they know they are being used to practice on by the next generation of doctors. And for this they pay £80bn in taxes. Its called the NHS. And how people love it, because it's "free"

Anonymous said...

Devil - by all means put the boot in on the NHS (again) but which system would deal most effectively with members of the public who demand an ambulance because they've got 'a really bad cold' - followed by the obligatory, yet pointless prescription for antibiotics, of course (after all who wants to get sued for missing a difficult to spot prodromal meningitis).

4.3million ambulances were called last year, and it represents an increase of 40% in demand.

Just think about that for a moment, four point fucking three MILLION 999 emergencies - and where do you think they all end up, why in A&E of course, especially since very few GPs provide out of hours care these days.

Remember, in order to be 'competative' and as 'productive' as possible beds have been reduced by almost 75% since the inception of the NHS,(from well over 400,000 in 1948 to round about 115-120,000 today) - we can all congratulate ourselves that hospitals are running efficiently at virtually 100% bed occupancy - hell, some psychiatric services 'hot bed' and run at 100+% (admitting a new patient after another is sent out on weekend leave).

You have decided to pick up on Dr Rant's observations, well may I respectfully suggest you also re-read some of his other posts on certain, aherm, 'heart sink' patients who tend to suck the life blood out of GPs, and indeed, any other health professional they come into contact with.

Perhaps they are the same sort of neurotics who call 999 when the missus feels a vague contraction when she was 8 months pregnant (the so called materni-taxi).
Mind you, at least that would be a medical reason, some imbeciles call ambulances because they are scarred of thunder, or because they want a hug.

But of course nobody is suitably qualified to triage the time wasters, apart from doctors, the use of paramedics or nurses in such roles would merely constitute quacktitoning of the first order.

No, I'm afraid ambulances will just have to wait while our productive and efficient hospitals make the very best use of the final 3 beds that remain unoccupied.

Anonymous said...

A&E Charge - The corruption begins because it's "free". People who had to pay for an ambulance would think long and deep before they called one if it cost the market rate of around £150 - £200. Cheaper to call a taxi. Or not go to the hospital at all.

The NHS is sickeningly corrupting.

Anonymous said...

The NHS was founded because too many young men of conscription age were found to be medically unfit during WW2.

If you think that the Private Sector holds all of the answers for healthcare provision then think again. Check out the complication rates for ISTCs whose medical negligence costs are met by the NHS. Virgin's foray into general practice will be transient for a number of reasons. Polyclinics have never worked elsewhere and will divert funding from general practice.

"The performance of A&E is symptom of how well the rest of the hospital performs" - utter cock from someone who has probably never set foot in an NHS hospital. In your ideal world you'll only have the "credit card check wait" before you're escorted to your private suite. Over your limit for the month ? Try the State shithole down the road mate !

Larry Teabag said...

People who had to pay for an ambulance would think long and deep before they called one if it cost the market rate of around £150 - £200. Cheaper to call a taxi. Or not go to the hospital at all.

Brilliant. I can't see any possible downside to that at all.

Anonymous said...

6:00 p.m. What have you got against a spotlessly clean private room with a private bathroom and your own TV and telephone, BTW? Are you a commie or something? You've paid for it with your NI contributions. Why should you share with people who haven't paid?

If you're not employed (except OAPs) and so haven't paid for it, then why would you get it for free? Does Starbucks give free coffee?

John Trenchard said...

for the love of god - can all you folks send this blogpost over to the U.S.

because Hilary and Obama think that the NHS is so wonderful...

i'll send the link on myself. but i hope others reading this will do the same.

John Trenchard said...

"The NHS was founded because too many young men of conscription age were found to be medically unfit during WW2. "

well, that was then , and this is now. so you think that the economics of 1940s britain should still apply to the 21st century?

have you noticed that our water supply is privatised? surely , before "health" one of the basic "rights" of human beings is access to water. but its privatised, and works reasonably well.

why not privatise the NHS?

there will be enormous knock on benefits - no more government "health" programs because for starters the chav lifestyle and "binge drinking" lifestyle will hit people in their fucking pockets.

right now , it doesnt. so they will continue on , as before.

Anonymous said...

Verity - giving a fuck about the poor, vulnerable & elderly doesn't make somebody a communist. You can have private rooms in the NHS if you need one. Such luxuries count for nothing if the private treatment is substandard. Your health care is being paid by those who don't currently need it - the clue's in the second word of NI. Let's hope you never develop a chronic disease or have positive pre-symptomatic gene testing for a nasty degenerative condition as the Private sector won't touch you. The PFI schemes have shown us how the private sector will improve healthcare in this country.

The two weeks on a trolley team said...

When I worked in kiddy A+E they reduced our numbers by 1.

So, we all just had to cover that spot on the rota.

We got paid locum rates for it.

Even at crappy NHS locum rates, it would have been so much cheaper to hire another doctor.

I think that hospital is still paying locums.


Dr Thunder

Anonymous said...

10:06 As I said, does Starbucks give free coffee?

I am baffled - well, not really, it's been so inbred into the Brits that it's almost a genetic disease in its own right by now - about why British people think healthcare should be free to all.

Re your snippy remarks about the elderly, in all my posts about the ghoulish NHS, I have always excluded the elderly from having to make provision for themselves, assuming that they contributed to the general weal throughout their working years, whether in the labour market or bringing up a family. So XXX that out of your deliberations.

Why do you think private treatment would be "substandard"? This is a very weird assumption. How did you come by this notion, given that you clearly have no experience of it. It is far better than treatment on the NHS because hospitals answer to shareholders.

As I have said 90,000 times, if you love the slovenly, rather creepy NHS so much, let them compete with the private sector and see how long they last. NI deductions should go to whatever private insurance company the salary-earner directs them to. The NHS should be one provider competing among many. They should have to compete to receive your deductions and handle your account.

John Trenchard said...

nearly every other country in the entire world seems to get along fine without an NHS.

my relatives in Ireland just have insurance , paid for by the employer as a perk. and there's no clamour for an NHS over there - in fact, it's looked down upon as an utter disaster. because it teaches the feckless morons of British society to not take responsibility for themselves.

Anonymous said...

Further to John Trenchard, where I am, if one wants to see a specialist, usually one can get an appointment within two days - or three if a weekend is involved.

If he orders tests, you take your tests to the lab in the morning and the computer printouts are ready for you to pick up by 4p.m. the same day. (The tests go to you, not the doctor, because you paid for them.) Ultrasound? X-rays? You give your prescription into the radiology department. You go back the next day to pay and pick them up. The scans/x-rays go to you, because you are the customer. You retain them.

If you want a second opinion, all your records are in your possession, and you just make an appointment with someone else and take everything along. There is no GP gatekeeper.

The whole system rolls along by people being willing to pay for their own healthcare. (Yes, there is provision for poor citizens - but not poor foreigners who shouldn't be there in the first place - don't worry.)

Your NI contributions, converted to private, should be enough insurance for you to receive similar treatment. Foreign passengers seeking heart transplants, etc., would have to be dumped. And Pakistanis with generations of first cousin marriages which have produced lifelong birth defects, would have to pay for their own, horrendously expensive, lifelong treatment. Boo. Hoo.

Anonymous said...

Also, the meanness of spirit from you affecionados of the USSR-esque NHS is unsettling. You would rather everywhere else fail rather than free enterprise be proved, as it has throughout human history, to be the best means of delivery of absolutely everything.

Remember when you could only send things through the Royal Mail?

Remember when ex-Viet Nam vet came back to the US and made the same discovery - the inefficiency, the smugness of the US Postal Service ... and started Federal Express? Now packages are delivered within three days, worldwide, and that includes Customs, and they invented tracking your personal package on the internet. They invented that internet pen you sign with. And they inculcated their staff in a pleasant and helpful attitude.

And they are so damn' reliable. Three days means three days.

Free enterprise.

It works in medicine, too. You get service, and you get it NOW.

Anonymous said...

Unfortunately criticism of the statist catastrophe that is the NHS is viewed as blasphemy, possibly the only true blasphemy left in the UK.

It is a bizarre psychosis that most of the population of Britain knows it is crap yet are horrified when it is criticized.

Anonymous said...

If anything, this thread proves that when people argue about the "NHS", they are often arguing about many different things.

Verity - I'd dearly love to see you walk into an NHS ITU and spout your cold war paranoia. Please explain to me how the PE-owned BUPA hope to out-compete in, say, the messy realities of polytrauma or acute mental health. Or how the beloved market works for a heartsink patient with an acute-on-chronic episode of COPD. Or how the oh-so-gleaming UK private sector would cope with providing 24/7 acute care (as opposed to elective surgery in the relatively fit and young, or overcharging for nursing home care). You obviously have very little understanding of health provision in the UK - or, indeed, who is actually providing it, making money from it, or going the extra mile in caring about it (ooh, check that developing global labour market for experienced nurses..). There's more to healthcare than having a fucking glass of wine with your meal, sunshine. Given the historic underspend, and notwithstanding NuLab's efforts to sell it off to square mile PFI del boys, there was truth in the old adage that "when the NHS is good, it's very, very good." You are being reductive if you think otherwise. Even the sternest of NHS critics can recognise that - but I guess dogma can get in the way when one is hunting commies, eh?

I'm all up for a constructive debate about healthcare and funding. I'd still like to hope for a healthcare system that is patient responsive, whilst not ignoring the vulnerable. But, boy, am I weary of internet commentators talking shite about jobs they'd never do themselves. I've said it before, but I've yet to see anybody come round from emergency surgery, and then complain about their tax burden.

Anonymous said...

Lost_Nurse, having missed the entire point of free enterprise throughout human history, writes - "I'm all up for a constructive debate about healthcare and funding." Well, that's bloody public-spirited of you, Sunshine, but,you have clearly not understood the problem.

See, Sunshine, it's not about "funding". That's where you communists fall down, Sunshine. You think "funding" rather than "profits". It's profits that make the world go round; not "funding".

"Verity - I'd dearly love to see you walk into an NHS ITU and spout your cold war paranoia." Well, you're doomed to disappointment on that one, Sunshine because I don't care enough about your self-created situation to do so. Also, I have no idea what you mean by "cold war paranoia". You mean, "free enterprise"? "Free markets in health care"?

Mixed wards, foetid wards, foul, filthy toilets ... snippy, lazy staff. People held outside the hospital in ambulances to meet government "targets" and meanwhile that ambulance is not available to other emergencies. It may be crap, but it's FREE! The envy of the world!

Waiting weeks to see a specialist; waiting months and in some instances years for an operation. I can see a specialist of my choice in two to three days.

The NHS is grotesque, Sunshine, and the concept needs to be revisited with a clear, analytical eye.

You people are defending the indefensible because you are so cowed by your government. Your NHS is roughly the equivalent of county hospitals in the US. They serve emergencies, low income and no income people. They definitely serve a purpose and they are good. But they are not what one should expect as the norm in health care provision in the 21st Century.

And I'll tell you what, Sunshine, your aggression is fuelled by chippiness which is another thing I loathe about the NHS.

Anonymous said...

Agression, Verity? What makes you think I even care? It's interesting that you dodge the ITU thing. I'm guessing you write from the US - I have no desire to import your medico-legal paralysis. I'd rather follow the example of our European neighbours, thanks.

I'm also guessing that I have rather more experience of waiting ambulances, mixed wards and filthy toilets than you do - and, in each case, a better understanding of the reasons why these things happen, not to mention who (to use the holy vernacular) is profiting from them. And it ain't communists, that's for sure.

I notice that you are careful to exclude care of the elderly from your free-market paradise. Why is that?

Anonymous said...

Lost_Nurse writes, inexplicably: " I've said it before, but I've yet to see anybody come round from emergency surgery, and then complain about their tax burden."

I'm sure that's the case. And I am equally sure it is equally rare to see anyone come round from surgery they have paid for through their insurance and then complain about the cost of the premiums. Your observation proves absolutely nothing.

Anonymous said...

Your observation proves absolutely nothing.

Except that the much-maligned NHS staff managed to do their jobs properly, efficiently and with all due care - despite your paranoia to the contrary. But good news - people just doin' their job - is no news, right?

Anonymous said...

Lost_Nurse - Oh! Was I aggressive, by your definition, darling? Sweetie, don't you think your post in response to mine was rather angry, chippy and reeked of insecurity.

But I'm so sorry, darling, if I upset you! I feel just awful! Honestly!

No, I'm not writing from the United States, dear thing - honestly! I love your hair! - although I do have experience of the American medical system and found it very good indeed. I also have experience of other non-european environments and to be candid - how can I put this without hurting your feelings? - everywhere is better than Britain.

Here again, you demonstrate that you have no concept of the free market in medical care, or its efficacy: I'm also guessing that I have rather more experience of waiting ambulances, mixed wards and filthy toilets than you do - and, in each case, a better understanding of the reasons why these things happen. See, here is your mistake. It doesn't matter "why these things happen" because they bloody shouldn't happen.

Oops! I wrote 'bloody'! I hope you're not offended!

Every time I have posted about the NHS, I have always made my position on OAPs absolutely clear and I am not going to bore the brains out of everyone by repeating it yet again.

Anonymous said...

It doesn't matter "why these things happen" because they bloody shouldn't happen.

Here's a thing - I agree entirely. What do ya suppose nurses think of contracted out cleaning and management consultancy inspired bed reductions? Here's another thing - I grasp the concepts of choice and competition just fine, thanks. Neither is being achieved by the witless privatisation of the NHS. And if you are unable to understand how previously "good" services (efficient, timely, effective) are now being fragmented in the UK, then I'm rather suspicious of your insights into British healthcare.

Devil's Kitchen said...


"Neither is being achieved by the witless privatisation of the NHS."

As I have said before, the NHS isn't really being privatised. Instead, we are getting a kind of half-way house wherein we get the worst of both public and private.


Anonymous said...

Lost_Nurse - the chippiness with which you mean-spiritedly assumed I was writing from the Great Capitalist Satan, the United States, was quite illuminating.

You don't seem to understand that the whole developed world has moved on since wartime, Labourite Britain.

(... although certainly Gordon Brown is doing his best to drag Britain back down to it.)

Anonymous said...

Instead, we are getting a kind of half-way house wherein we get the worst of both public and private.

I am well aware of the implied difference, DK. I have nothing against the private sector - except where it's being used inappropriately (PFI, ISTC etc), and to massive cost. My point - and I stand by this - is that much that is good is being thrown away, aided by half-truth and kneejerk sentiment.

Verity - it was a guess based on your description of county hospitals. Reasonable, I'd have thought. FWIW, I'm happy to keep on utilising US technology and kit. Not so keen on United Health taking over vast chunks of UK primary care. Not sure that makes me a socialist, but there you go.

Anonymous said...

Lost_Nurse - Fair enough. I did live in the US and I have experienced medical care. However, I referred to other areas of the world, much of which has long overtaken Britain and the communist NHS.

FYI, as I noted, the NHS strikes me as being similar to US county hospitals and I have a friend who is an emergency nurse in one of them. After several years, he got fed up and got a job at a large private hospital in the suburbs and it drove him nuts. He couldn't stand having to deal with little boys with sprained ankles from kicking soccer balls from the wrong angle when he was accustomed to holding down raving drug addicts with stab wounds while a a doctor tried to examine her. He missed the shootings. He missed the whores staggering in after a beating by their pimps. In other words, he missed the theatre and - I assume - the adrenalin. He went back.

To each his own.

Anonymous said...

he missed the theatre...

I can understand that (without wanting to make it sound like entertainment - I think people miss the intensity), though many would also fear the burn-out. There's another angle, too - trauma staff get good at their jobs the hard way. In an ideal world, healthcare would be very boring... :)

Anonymous said...

Devil's Kitchen said:
"As I have said before, the NHS isn't really being privatised. Instead, we are getting a kind of half-way house wherein we get the worst of both public and private."

This is what's worrying about the way that the proposed GP super-surgeries will be run. Enterprises like this deserve better management than the NHS bureaucracy. In my view companies like Spire or United Healthcare should be allowed to operate them. Management of a multi-disciplinary operation like this is well beyond the capability of clinicians whose talents would be better served doing the job they were trained for, i.e. caring for patients.

Anonymous said...

With respect, David, here is where your logic falls down: "In my view companies like Spire or United Healthcare should be allowed to operate them."

Why "allowed"? It smacks of a controlling government.

Why can't Spire or United Healthcare just win a bid and do it?

Get rid of this post-First World War government interference with every bloody thing. When WWII came along, the Brits had become conditioned to understand that the "government", however incompetent the men making it up, was their boss. WWII and Attlee and Bevan were continuations of this urge to control entire populations.

There is expertise and there is kindness to be found in the NHS, but it is monstrous and its tentacles squeeze the life out of free enterprise. And capitalism is always to be the desired option.

WWI, apart from being a tragedy of such horrifying dimension - was the beginning of the deconstruction of British democracy.

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